Basic Information
| Provider Information | |||||||||
| NPI: | 1265588966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADIRONDACK UROLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 PARK STREET | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128014449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187981719 | ||||||||
| FaxNumber: | 5187981943 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 PARK STREET | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128014449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187981719 | ||||||||
| FaxNumber: | 5187981943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 12/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | SLATCH | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5187981719 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.